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Abstract

Objective: To describe a simple protocol
for ventilator-assisted preoxygenation
(VAPOX) prior to rapid sequence intubation
in the ED using a Hamilton T1
ventilator in an effort to further reduce
the incidence of transient and critical
hypoxaemia.
Methods: Ventilator-assisted preoxygenation
includes the following steps;
preparation for rapid sequence intubation
as per institutional protocols,
including departmental checklists.
Hamilton T1 ventilator is setup in
non-invasive spontaneous/timed mode
with settings as described. The patient
is optimally positioned and nasal cannula
applied with an oxygen flow ...View more >Objective: To describe a simple protocol
for ventilator-assisted preoxygenation
(VAPOX) prior to rapid sequence intubation
in the ED using a Hamilton T1
ventilator in an effort to further reduce
the incidence of transient and critical
hypoxaemia.
Methods: Ventilator-assisted preoxygenation
includes the following steps;
preparation for rapid sequence intubation
as per institutional protocols,
including departmental checklists.
Hamilton T1 ventilator is setup in
non-invasive spontaneous/timed mode
with settings as described. The patient
is optimally positioned and nasal cannula
applied with an oxygen flow rate
of 15 L/min. A face mask is applied
with the jaw pulled forward using a
two-handed thenar eminence grip and
the ventilator is started. Preoxygenation
occurs for 3min. Drugs including neuromuscular
blockers are administered,
while the operator ensures the airway
remains patent. The ventilator
transitions into Pressure Controlled
Ventilation once apnoea ensues.
Nasal oxygen continues until endotracheal
tube is successfully secured.
Results: We describe a case series of
the first eight consecutive adult patients
on who VAPOX was applied.
All eight patients were clinically
deemed at high risk of oxygen
desaturation. No clinically significant
hypoxia occurred, and the lowest
oxyhaemoglobin desaturation was
92%.
Conclusion: Preoxygenation using a
ventilator with an open valve system
may allow safe combination of noninvasive
ventilation, pressure controlled
ventilation and apnoeic oxygenation
using nasal cannula. VAPOX may be
the technique of choice to preoxygenate
and apnoeic oxygenate many patients
who undergo rapid sequence intubation
in the ED equipped with these
ventilators.View less >